Postoperative Weight Gain Research Articles

Tu1820 High Protein Diet (HPD) Improves Post-Operative Weight Gain After Massive Small Bowel Resection

Tu1820 High Protein Diet (HPD) Improves Post-Operative Weight Gain After Massive Small Bowel Resection

Post-operative Weight Gain After Total Knee Arthroplasty: Prevalence and Its Possible Attenuation Using Intraoperative Sensors

As the proportion of adults with obesity continues to climb, so too does the need for total knee arthroplasty. Unfortunately, total knee replacement patients often experience post-operative weight gain, despite improved joint function. The purposes of this study were: 1) To execute a literature meta-analysis in order quantify the changes in body mass that are typically observed following TKA, and 2) Evaluate data from a prospective, multicenter study to assess any trends towards weight loss in a group of “balanced”, sensor-assisted TKA patients. The literature review found that average proportion of patients who had weight gain after TKA is 47% to 66%. In literature, the average post-operative weight gain was 9.5 lbs. (1.6 kg/m2 BMI increase), up to 14 lbs. (2.3 kg/m2). In the multicenter study, only 30.4% of patients and 36.9% of patients exhibited weight gain at 6 months and 1 year, respectively. At the 1-year interval, this indicates an 11% decrease from reported averages (p=0.049), up to 29% as reported by the NIH (p<0.001). The average weight gain in the multicenter patient group was 4.3 lbs. (0.72 kg/m2 BMI increase) at 6 months, and 3.5 lbs. (0.58 kg/m2) at 1 year, both of which are non-clinically meaningful. The average weight loss of those in the non-gaining group was 7.8 lbs. (1.3 kg/m2) at 6 months and 9.6 lbs. (1.6 kg/m2) at 1 year. Both of these values are clinically meaningful. This evaluation demonstrates that weight gain after TKA is prevalent, but ensuring soft-tissue balance (via technologies such as intraoperative sensing) may help mitigate this expected increase in body mass.Keywords: total knee arthroplasty, increased BMI, intraoperative sensors, weight gain, obesity

MP71-20 ABSORPTION OF IRRIGATION FLUID IS FREQUENTLY DETECTABLE DURING 180W 532-NM LASER VAPORIZATION OF THE PROSTATE: RESULTS FROM A PROSPECTIVE INVESTIGATION USING BREATH ETHANOL MEASUREMENTS

INTRODUCTION AND OBJECTIVES: Laser vaporization (LV) of the prostate using the 532-nm laser is a recommended treatment option for patients with prostatic bladder outlet obstruction and particularly for those with significant cardiovascular comorbidities. Despite the excellent coagulation properties of the laser, fluid absorption was frequently detectable during 120W LV of the prostate. For the nextgeneration 180W laser, a better coagulation technology has been announced. If fluid absorption occurs during LV using this improved but also more powerful laser is unknown. METHODS: Intraoperative fluid absorption was investigated during routine LV using the 180W Greenlight XPS laser (AMS, USA) in 32 consecutive patients. For this purpose intraoperative irrigation was performed using saline containing 1% ethanol. Measurements of breath ethanol were performed every 10 minutes during the operation with a conventional alcometer. The volume of fluid absorption was calculated from these results. Intraoperative changes in hemoglobin (Hb), hematocrit (Hct), venous pH and serum Na, K, Cl, HCO3 were also recorded. Statistical analysis was done using Mann Whitney U test and Wilcoxon signed-rank test. RESULTS: Median age was 73 y (range: 56 85 y), median prostate volume 50 ml (20 99 ml). The median operative time was 60 min (30-150 min), the intraoperative irrigation volume 21 L (6 42 L), and the applied laser energy 175 kJ (70 e 544 kJ). 17 patients (53%) had a positive ethanol test. The median calculated absorption volume in these patients was 827 ml (138 e 4808 ml). In the absorber group, a significant decrease in Hb, Hct, HCO3, pH (p1⁄40.001, 0.004, 0.002 and 0.02, respectively), and a significant increase in serum Cl (p1⁄40.007) were detectable. The changes in Hb, Hct, Cl and HCO3 were significantly greater compared to the non-absorber group (p1⁄40.005, 0.02, 0.001 and 2000ml) were prolonged metabolic acidosis and somnolence, hypothermia, jugular venous distension and significant postoperative weight gain. CONCLUSIONS: Intraoperative fluid absorption occurs in a significant proportion of patients during 180W LV of the prostate. Fluid absorption can be excessive and thus clinically relevant. Early identification of fluid absorption using the ethanol breath test enables timely interventions. If ethanol monitoring is not available, changes in Hb, Hct, pH, HCO3 and Cl can be used to detect potentially dangerous fluid absorption.

Effects of hyperoncotic cardiopulmonary bypass prime on extravascular lung water and cardiopulmonary function in patients undergoing coronary artery bypass surgery

To investigated the effect of a hyperoncotic CPB-prime with hydroxyethyl starch (HES) 6% (130/0.4) on extravascular lung water (EVLW) and post-pump cardiac and pulmonary functions. This study plan approved by the hospital ethics committee review. In 40 randomized patients undergoing elective coronary artery bypass graft surgery (CABG), a colloid prime (COP:42.5 mmHg, HES-group, n = 20) and a crystalloid prime (Ringer's lactate, crystalloid group, n = 20) of equal volume were compared with respect to the effects on cardiopulmonary function. Cardiac index (CI), mean arterial pressure (MAP), pulmonary capillary wedge pressure (PCWP), systemic vascular resistance index (SVRI), pulmonary artery pressure (PAP), pulmonary vascular resistance index (PVRI), alveolo-arterial oxygen difference (AaDO2), pulmonary shunt fraction (Qs/QT), extravascular lung water (EVLW), COP, fluid balance and body weight were evaluated peri-operatively. Pre-operative demographic and clinical data, CPB-time, crossclamp time and the number of anastomoses were comparable for both groups. During CPB, COP was reduced by 22% in the HES-group [(16.7 ± 3.9) vs (21.5 ± 2.2) mmHg, P < 0.05] while it was reduced by more than 50% of the pre-CPB value [10.7 ± 2.0 vs (22.7 ± 1.9) mmHg, P < 0.05] in the crystalloid group (P < 0.05 HES-group vs. crystalloid group). Post-CPB EVLW was unchanged in the HES-group but it was elevated by 21% in the crystalloid group (P < 0.05 HES-group vs crystalloid group), CI was higher in the HES-group [(3.3 ± 0.3) vs (2.7 ± 0.7) L/min, P < 0.05]. Fluid balance was less in the HES-group (715 ± 544 vs 1 951 ± 487, P < 0.05). Post-operative weight gain could be prevented in the HES-group but not in the crystalloid group (1.4 ± 1.1 vs -0.3 ± 1.3, P < 0.05). No significant differences were seen for MAP, PAP, PCWP, SVRI, PVRI, AaDO2 and (Qs/QT) between the two groups at any time. Hyperoncotic CPB-prime using HES 6% improves CI and prevents EVLW accumulation in the early post-pump period, while pulmonary function is unchanged.

Double Incomplete Pyloromyotomy (A. Ezzat Technique): A New Technique for Infantile Hypertrophic Pyloric Stenosis: Preliminary Study

Background-Purpose: The study aimed to see the outcome of Double Incomplete Pyloromyotomy as new technique for surgical management of infantile hypertrophic pyloric stenosis (IHPS). Methods: This study was conducted in pediatric surgery unite, Zagazig University Hospital, Egypt. Fifteen patients were included in this study (11 male and 4 female) with IHPS from January 2012 to January 2013. Under general anesthesia, two longitudinal separated incisions at different planes as pyloromyotomy. Results: Postoperative vomiting and weight gain were recorded. Follow up period was 3 months. Vomiting improved within first 48 hours then stopped after that. Weight gain significantly increased after theoperation when compared preoperatively. Conclusion: Double Incomplete Pyloromyotomy is a new, safe and effective procedure for treatment of infantile hypertrophic pyloric stenosis.

Growth and weight of children with craniopharyngiomas based on the tumour location and growth pattern

This study aimed to characterise the weight and growth of children with craniopharyngiomas and to analyse the role of the tumour location and growth pattern in the development of obesity and growth retardation in these children. We retrospectively analysed the records of 109 consecutive children with primary craniopharyngiomas. The patients were divided into two subgroups according to the location of the tumour: intrasellar (Group A); and the floor of the third ventricle (Group B). Height and body mass index were measured at standardised ages and at time points before, after, and at the time of diagnosis. Endocrinological and hypothalamic measurements before and after surgery were compared. Reduced growth rates occurred in early infancy and persisted until diagnosis in Group A, but were only present from age 5–6 in Group B. Therefore, reduced growth rates occur early in the history of intrasellar tumours, whereas rapid postoperative weight gain invariably occurs in patients with third ventricle tumours, which is a significant predictive factor for severe long term obesity in patients with childhood craniopharyngiomas.

Weight Change and Clinical Outcomes Following Adult Spinal Deformity Surgery in Overweight and Obese Patients

Study DesignRetrospective comparative study. Summary of Background DataThe effect of spine surgery on postoperative weight loss or weight gain in overweight and obese spinal deformity patients is unknown. ObjectiveTo evaluate the postoperative outcomes and weight changes in adult patients undergoing spinal deformity surgery. Materials and MethodsA total of 104 adult patients undergoing primary spinal deformity surgery were enrolled. All patients had a minimum 2-year follow-up (average, 50.1 months). Preoperative and latest follow-up, body mass index (BMI), Oswestry Disability Index, Scoliosis Research Society (SRS)-22 self-image and SRS outcomes scores were collected. Instrumented levels, estimated blood loss, major and minor complications, length of hospitalization, and hospital discharge status were also reviewed and compared. ResultsA total of 66 patients were overweight (BMI > 25–29.9; average, 26.9) (Group OW), whereas 38 patients were obese (BMI > 30; average, 33.5) (Group OB). The average age was 54.5 in Group OW and 48.6 in Group OB (p < .01). Postoperatively, significant changes were not found in the BMI for Group OW, 27.2 (26.9–27.2; p < .39), and for Group OB, 35 (33.5–35; p < .06). Postoperatively, significant improvements were seen in both groups for Oswestry Disability Index (36.1–21.8, Group OW; 44.1–24.4, Group OB; p <.001), SRS self-image (2.9–3.7, Group OW; 2.6–3.8, Group OB; p < .001) and SRS score (3.1–3.8, Group OW; 2.9–3.8, Group OB; p < .001). There were no significant differences in complications between groups. ConclusionsAs a group, overweight and obese primary spinal deformity patients did not demonstrate significant weight gain or weight loss from preoperative to latest follow-up. However, both overweight and obese patients had significant improvements in outcome scores at latest follow-up and equivalent rates of complications.

Cachexia in Patients with Chronic Pancreatitis and Pancreatic Cancer: Impact on Survival and Outcome

Chronic pancreatitis (CP) and pancreatic adenocarcinoma (PDAC) are the most common diseases of the pancreas. Cachexia—weight loss exceeding 10% of stable body weight—is present in up to 80% of patients with PDAC. Because the mechanisms of cachexia are not well known, this provides a possibility to compare clinical courses of benign and malignant cachexia. In this study, 382 patients—242 with a PDAC stage UICC II/ 140 with CP—were documented regarding the prevalence of cachexia and its influence on perioperative morbidity and mortality with a special interest to postoperative weight gain and survival. Cachexia was present in 41.4% of CP and 31% of cancer patients. We could demonstrate more pronounced systemic effects of cachexia in patients with PDAC. Weight loss was faster in PDAC patients, the amount of weight loss did not differ significantly between the groups. Cachexia had a significant impact on survival and the postoperative course in patients with PDAC and tumor resection. The development of cachexia is faster in patients with a malignant disease and the systemic effects are more pronounced. Therefore, tumor cachexia should be considered as a different entity than cachexia in benign diseases.

Attenuation of rat chronic small bowel allograft rejection by n‐3 polyunsaturated fatty acids is associated with reduced expression of graft IL‐15

Interleukin-15 was found to play key roles in various immunological processes including chronic rejection after renal and cardiac transplantation. n-3 polyunsaturated fatty acids (n-3 PUFA) have shown beneficial effects to chronic allograft rejection. The objective of this study is to search the possible mechanism of this inhibitory effect in chronic small bowel allograft rejection. Animals were divided into three groups: isograft (CsA+corn oil-supplemented diet); allograft (CsA+corn oil-supplemented diet); and allograft (CsA+fish oil-supplemented diet). Donor intestines from F344 rats were transplanted orthotopically into Lewis rat recipients. CsA was administered at 5mg/kg/day for 2wk post-operatively. Post-transplant weight was recorded. Histopathological changes and graft IL-15 expression were measured on POD 90. Chronic small bowel allograft rejection developed on POD 90. n-3 PUFA significantly decreased the score of chronic rejection and increased the post-operative weight gain rate. This attenuation is associated with reduced graft IL-15 expression. n-3 PUFA contributed to improved pathological and clinical outcome during chronic small bowel allograft rejection, and this improvement was associated with reduced graft IL-15 expression.

Radiofrequency is a secure and effective method for pancreatic transection in laparoscopic distal pancreatectomy: results of a randomized, controlled trial in an experimental model

Postoperative pancreatic fistula (PPF) is the most frequent and serious complication after laparoscopic distal pancreatectomy (LDP). Our goal was to compare the performance, in terms of PPF prevention, and safety of a radiofrequency (RF)-assisted transection device versus a stapler device in a porcine LDP model. Thirty-two animals were randomly divided into two groups to perform LDP using a RF-assisted device (RF group; n=16) and stapler device (ST group; n=16) and necropsied 4weeks after surgery. The primary endpoint was the incidence of PPF. Secondary endpoints were surgery/transection time, intra/postoperative complications/deaths, postoperative plasmatic amylase and glucose concentration, peritoneal liquid amylase and interleukin 6 (IL-6) concentrations, weight variations, and histopathological changes. Two clinical and one biochemical PPF were observed in the ST and RF groups respectively. Peritoneal amylase concentration was significantly higher in the RF group 4days after surgery, but this difference was no longer present at necropsy. Both groups presented a significant decrease in peritoneal IL-6 concentration during the postoperative follow-up, with no differences between the groups. RF group animals showed a higher postoperative weight gain. In the histopathological exam, all RF group animals showed a common pattern of central coagulative necrosis of the parenchymal surface, surrounded by a thick fibrosis, which sealed main and secondary pancreatic ducts and was not found in ST group. The fibrosis caused by an RF-assisted device can be at least as safe and effective as stapler compression to achieve pancreatic parenchyma sealing in a porcine LDP model.

Tumor origin and growth pattern at diagnosis and surgical hypothalamic damage predict obesity in pediatric craniopharyngioma

Severe obesity is a major problem in pediatric craniopharyngioma. We investigated whether tumor origin, growth pattern, and surgical damage predict obesity in pediatric craniopharyngioma. Subjects were 58 patients (30 males) with no tumor recurrence during the first postoperative 18 months. Preoperative hypothalamic involvement was classified into no (pre_G0, n = 19), little (pre_G1, n = 21), and severe (pre_G2, n = 18) involvement groups based on sub- or supradiaphragmatic tumor origin and growth patterns. Postoperative hypothalamic involvement was classified into no (post_G0, n = 4), minimal (post_G1, n = 19), and significant (post_G2, n = 35) involvement groups according to follow-up imaging. The prevalence of obesity increased from 13.2 % at diagnosis (mean age = 8.1 years) to 37.9 % at last follow-up (mean duration = 9.1 years). Only the body mass index (BMI) Z-score increment of the first postoperative year (first-year ΔBMI_Z) was significant (P = 0.007). Both the preoperative BMI_Z (P = 0.001) and the first-year ΔBMI_Z (P = 0.017) showed an increasing trend from the pre_G0 to pre_G1 to pre_G2 group. For the 40 patients with pre_G0 or pre_G1, the first-year ΔBMI_Z was higher in the post_G2 group than the post_G1 group (0.02 ± 0.91 vs. 0.89 ± 0.72, P = 0.003). Tumor origin and growth pattern affect preoperative BMI_Z and postoperative weight gain. Despite little or no hypothalamic involvement at diagnosis, surgical damage contributes to postoperative weight gain in patients with craniopharyngioma.

Sex, Food and Threat: Startling Changes after Subthalamic Stimulation in Parkinson's Disease

BackgroundChanges in motivational processing may play a role in weight gain and other non-motor side effects in Parkinson's disease (PD) patients treated with deep brain stimulation of the subthalamic nucleus. Objective/hypothesisWe aimed to assess changes in aversive and appetitive motivational activation using modulation of the acoustic blink reflex (ABR) by rewarding and aversive stimuli. MethodsABR elicited during the viewing of erotic, food, aversive and neutral pictures was recorded in 11 off-medicated patients with the subthalamic stimulation switched ON and OFF, and in 11 control subjects. ResultsABR to erotic stimuli was larger in patients in the ON compared to the OFF condition and controls (P < 0.01). Aversive stimuli caused a larger increase in the ABR in patients with the ON condition than in controls (P < 0.05). Additionally, we found a negative correlation of the ABR magnitude to food pictures in the ON condition with weight gain following subthalamic stimulation (P < 0.01, after adjustment to OFF condition). ConclusionsOur results suggest that subthalamic stimulation affects motivational processing. Subthalamic stimulation may disturb appetitive engagement by erotic cues and increase aversive activation in PD patients. Additionally, postoperative weight gain may be related to changes in the processing of food cues due to subthalamic stimulation.

Tissue Engineering the Small Intestine

Short bowel syndrome (SBS) results from the loss of a highly specialized organ, the small intestine. SBS and its current treatments are associated with high morbidity and mortality. Production of tissue-engineered small intestine (TESI) from the patient's own cells could restore normal intestinal function via autologous transplantation. Improved understanding of intestinal stem cells and their niche have been coupled with advances in tissue engineering techniques. Originally described by Vacanti et al of Massachusetts General Hospital, TESI has been produced by in vivo implantation of organoid units. Organoid units are multicellular clusters of epithelium and mesenchyme that may be harvested from native intestine. These clusters are loaded onto a scaffold and implanted into the host omentum. The scaffold provides physical support that permits angiogenesis and vasculogenesis of the developing tissue. After a period of 4 weeks, histologic analyses confirm the similarity of TESI to native intestine. TESI contains a differentiated epithelium, mesenchyme, blood vessels, muscle, and nerve components. To date, similar experiments have proved successful in rat, mouse, and pig models. Additional experiments have shown clinical improvement and rescue of SBS rats after implantation of TESI. In comparison with the group that underwent massive enterectomy alone, rats that had surgical anastomosis of TESI to their shortened intestine showed improvement in postoperative weight gain and serum B12 values. Recently, organoid units have been harvested from human intestinal samples and successfully grown into TESI by using an immunodeficient mouse host. Current TESI production yields approximately 3 times the number of cells initially implanted, but improvements in the scaffold and blood supply are being developed in efforts to increase TESI size. Exciting new techniques in stem cell biology and directed cellular differentiation may generate additional sources of autologous intestinal tissue for direct translation to human therapy.

Intraoperative Fluids

There is increasing evidence that intraoperative fluid therapy decisions may influence postoperative outcomes. In the past, patients undergoing major surgery were often administered large volumes of crystalloid, based on a presumption of preoperative dehydration and nebulous intraoperative 'third space' fluid loss. However, positive perioperative fluid balance, with postoperative fluid-based weight gain, is associated with increased major morbidity. The concept of 'third space' fluid loss has been emphatically refuted, and preoperative dehydration has been almost eliminated by reduced fasting times and use of oral fluids up to 2 h before operation. A 'restrictive' intraoperative fluid regimen, avoiding hypovolaemia but limiting infusion to the minimum necessary, initially reduced major complications after complex surgery, but inconsistencies in defining restrictive vs liberal fluid regimens, the type of fluid infused, and in definitions of adverse outcomes have produced conflicting results in clinical trials. The advent of individualized goal-directed fluid therapy, facilitated by minimally invasive, flow-based cardiovascular monitoring, for example, oesophageal Doppler monitoring, has improved outcomes in colorectal surgery in particular, and this monitor has been approved by clinical guidance authorities. In the contrasting clinical context of relatively low-risk patients undergoing ambulatory surgery, high-volume crystalloid infusion (20-30 ml kg(-1)) reduces postoperative nausea and vomiting, dizziness, and pain. This review revises relevant physiology of body water distribution and capillary-tissue flow dynamics, outlines the rationale behind the fluid regimens mentioned above, and summarizes the current clinical evidence base for them, particularly the increasing use of individualized goal-directed fluid therapy facilitated by oesophageal Doppler monitoring.

Weight Gain after Adenotonsillectomy Is More Common in Young Children

Adenotonsillectomy (TA), performed for obstructive sleep apnea (OSA) or recurrent tonsillitis (RT), has been associated with weight gain after surgery. The objective of this study was to look at a large population of children undergoing TA and the demographic factors that contribute to postoperative weight gain. Case series with retrospective chart review. Tertiary, urban academic care center. Children undergoing TA at an academic center between 2008 and 2011 were included in this study. Demographic data (age, gender, race), OSA disease severity, preoperative and 3- to 6-month postoperative normalized body mass index (BMI; z-scores), and changes in z-scores were compared. Complete weight data after TA were available for 115 children, 85 of whom underwent surgery for OSA. Mean age (7.2 ± 4.3 vs 7.3 ± 4.4 years, P = .955) and gender distribution (38% female vs 50% male; P = .323) were similar for the OSA and RT groups. However, children with OSA were more likely to be black (60% vs 33%) than RT patients (P = .026). Overall, the preoperative BMI z-score increased from 0.98 ± 1.50 to 1.21 ± 1.25 (P = .0009) with no difference by surgical indication (P = .58). Multiple linear regression analysis demonstrated that only age was significantly, and negatively, associated with changes in BMI z-scores (P = .015). Similar to previous studies, children had weight gain after TA. In this analysis, younger age (≤ 6 years) was a significant predictor of postoperative weight gain. Future research should prospectively evaluate the association between weight gain and demographic factors in children undergoing TA, with special attention to the relationship with age.

Comparação dos níveis plasmáticos de grelina nos períodos pré e pós-operatório em pacientes submetidos à plicatura gástrica associada à fundoplicatura

The recurrence of the gastroesophageal reflux disease may be related to later postoperative weight gain, therefore increasing the chances of developing columnar metaplasia and cancer. The gastric plication associated with fundoplication can be employed in order to be treating the two issues. To evaluate the serum ghrelin hormone in pre and postoperatively as well as weight loss and control of reflux disease in patients undergoing gastroplication associated with fundoplication. Was performed laparoscopic gastric plication with fundoplication in eight patients; endoscopic examinations were performed pre and postoperatively as well as blood collection for ghrelin hormonal dosage. There was control of reflux symptoms and mucosal lesions. Weight loss was significant. Since the change of the hormone ghrelin was not of great significance. Gastric plication associated with fundoplication was effective in treating reflux disease with surgical indication and for weight loss in obese patients. Appetite control occurs, but not due to ghrelin, because no significant decrease of its plasmatic levels was observed.

Surgical Management of Infantile Hypertrophic Pyloric Stenosis by Double-Y Pyloromyotomy: A Better Approach

Background: Various treatment modalities have been applied for the management of infantile hypertrophic pyloric stenosis. However surgery remains the mainstay of treatment for IHPS of which Ramstedt's pyloromyotomy remains the surgical technique of choice. Objective: To see the outcome of surgical management of infantile hypertrophic pyloric stenosis by double-Y pyloromyotomy. Methods: A prospective interventional study of 40 patients with IHPS was carried out over a period of 2 years from July 2008 to July 2010. The patients were divided into 2 equal groups of 20 patients in each. All patients selected for study were optimized preoperatively regarding to hydration, acid-base status and electrolytes imbalance. All surgeries were performed after obtaining informed consent. Standard preoperative preparation and postoperative feeding regimes were used. The patients were operated on an alternate basis, i.e., one patient by Double-Y Pyloromyotomy (DY) and the next by a Ramstedt's Pyloromyotomy (RP). Data on patient demographics, operative time, anaesthesia complications and postoperative complications including vomiting and weight gain were collected. Patients were followed up for a period of 3 months postoperatively. Statistical assessments were done by using t test. Results: From July 2008 through July 2010, forty patients were finally analyzed for this study. Any statistical differences were observed in patient population regarding age, sex, weight at presentation, symptoms and clinical condition including electrolytes imbalance and acid-base status were recorded. Significant differences were found in postoperative vomiting and weight gain. Data of post operative vomiting and weight gain in both groups were collected. Vomiting in double-Y(DY) pyloromyotomy group vs Ramstedt's pyloromyotomy (RP) group was significant (p= 0.0001). Weight gain after 1st 10 days DY vs RP is 298 ± 57.94 gm vs 193±19.8 gm (p=0.0014), after 1 month 676.67±149.84 gm vs 466.67 ± 127.71 gm (p=0.0001), after 2 months 741.33± 278.74 gm vs 490±80.62 gm (p=0.002) and after 3 months 582±36.01gm vs 453.33±51.64 gm (p=0.0001). No long-term complications were reported and no re-do pyloromyotomy was needed.Conclusion: The double-Y pyloromyotomy seems to be a better technique for the surgical management of IHPS. It may offer a better functional outcome in term of postoperative vomiting and weight gain. J Shaheed Suhrawardy Med Coll, 2011;3 (2): 38-40 DOI: http://dx.doi.org/10.3329/jssmc.v3i2.12076

Risk factors for postoperative complications after fast‐track abdominal hysterectomy

Fast-track regimen has been shown to reduce postoperative complications in gastrointestinal surgery. We investigated the incidence and type of postoperative complications and associated risk factors after benign abdominal hysterectomy undertaken in a fast-track program. A prospective longitudinal cohort study. In five Swedish hospitals, a cohort of 162 women, ASA 1-2, undergoing abdominal hysterectomy in a fast-track program was prospectively studied. Surgery was performed under spinal or general anaesthesia. The fast-track concept was standardised with discharge criteria and a restricted intravenous fluid regimen. Complications were systematically registered during the five-week follow-up period. Risk factors for complications were analysed using multiple logistic regression models. Forty-one (25.3%) developed postoperative complications, mainly infection and wound healing complications. The majority of the complications developed after discharge and were treated in the outpatient clinics. Four women (2.5%) were readmitted to hospital. Substantial risk factors for postoperative complications were obesity (OR 8.83), prior laparotomy (OR 2.92) and relative increase in body weight on the first postoperative day (OR 1.52). Minor infection and wound healing complications seem to be common in healthy women undergoing abdominal hysterectomy in a fast-track program. Obesity is an important risk factor also in fast-track abdominal hysterectomy. A modest increase in postoperative relative weight gain during the first postoperative day seemed to increase the risk of postoperative complications. This factor merits further study. Randomised studies are necessary to determine the impact of fast-track program and perioperative fluid regimens on postoperative complications.

Weight Loss and Sleep‐Disordered Breathing in Childhood Obesity: Effects on Inflammation and Uric Acid

Sleep-disordered breathing (SDB) is prevalent in childhood obesity. It may be an independent risk factor for the metabolic syndrome. Possible mechanisms are inflammation and oxidative stress. Adenotonsillectomy in childhood obesity is associated with a high recurrence rate and risk of postoperative weight gain. Therefore, this study assessed the effects of SDB on inflammation and oxidative stress in childhood obesity before and after weight loss. We included 132 obese subjects between 10 and 18 years consecutively. Median age was 15.4 years (10.1-18.0). Mean BMI z-score was 2.72 ± 0.42. Leukocytes and differentiation, high sensitivity C-reactive protein (hs-CRP), and uric acid (UA) were determined at baseline and subjects underwent a sleep assessment. SDB was diagnosed in 39%. Linear regression analysis showed an association between UA(log) and oxygen desaturation index(log) (ODI(log)) (r = 0.20; P = 0.03), between leukocytes(log) and respiratory disturbance index(log) (RDI(log)) (r = 0.23; P = 0.01), and between lymphocytes(log) and RDI(log) (r = 0.19; P = 0.04). Follow-up was organized after 4-6 months of treatment. Median decrease in BMI z-score was 32%. Laboratory measurements were repeated. Subjects with SDB at baseline underwent a second sleep study. Of these 49 subjects, 12 showed residual SDB. This corresponds with a treatment success rate of 71%. Unlike changes in inflammatory markers, improvements in UA were associated with improvements in RDI and ODI (respectively: r = 0.44; P = 0.007, r = 0.41; P = 0.01). In conclusion, weight loss is effective in treating obese children with SDB. At baseline, a link exists between inflammation and SDB. Oxidative stress is reflected by UA at baseline and the concentration decreases after treatment according to improvements in SDB.

Free‐living energy expenditure reduced after deep brain stimulation surgery for Parkinson’s disease

The clinical picture in Parkinson's disease (PD) is characterized by bradykinesia, rigidity, resting tremor and postural instability. In advanced stages of the disease, many patients will experience reduced efficacy of medication with fluctuations in symptoms and dyskinesias. Surgical treatment with deep brain stimulation in the subthalamic nucleus (STN-DBS) is now considered the gold standard in fluctuating PD. Many patients experience a gain of weight following the surgery. The aim of this study was to identify possible mechanisms, which may contribute to body weight gain in patients with PD following bilateral STN-DBS surgery. Ten patients with PD were studied before bilateral STN-DBS surgery, and seven patients were studied again 3 and 12 months postoperatively. Clinical examination and resting metabolic rate with and without medical treatment was measured before and after STN-DBS. Furthermore, free-living energy expenditure, body composition, energy intake, peak oxygen consumption, maximal workload and leisure time physical activity were measured before and 3 and 12 months after surgery. The STN-DBS operated patients had a significant weight gain of 4·7 ± 1·6 kg (mean ± SE) 12 months postoperatively, and the weight gain was in the fat mass. The free-living energy expenditure decreased postoperatively 13 ± 4% even though the reported dietary intake was reduced. A decreased energy expenditure took place in the non-resting energy expenditure. The reported daily leisure time activity, peak oxygen consumption and maximal workload were unchanged. The STN-DBS operated patients have a significant postoperative weight gain, as a result of a decrease in free-living energy expenditure concomitant with an insufficient decrease in energy intake.